Prognostic significance of complement factors in severely ill patients with COVID-19

Abstract

Coagulopathy, cytokine release, platelet hyperactivity and endothelial activation are regarded as potential major contributors to COVID-19 morbidity. Complement activation might provide a bridge linking these factors in severe COVID-19 illness. In this study, we investigated the prognostic significance of selected complement factors in hospitalized patients with severe COVID-19 infection. The study included 300 hospitalized adults with severe COVID-19 infection. Complement factors (C3, C3a, C4, sC5b-9) were assessed by commercial ELISA kits. Outcome parameters included mortality, intensive care unit admission and duration of hospital stay. It was found that survivors had significantly higher serum C3 (median (IQR): 128.5 (116.3–141.0) mg/dL vs 98.0 (70.0–112.8) mg/dL, p<0.001) and C4 (median (IQR): 36.0 (30.0–42.0) mg/dL vs 31.0 (26.0–35.0) mg/dL, p<0.001) levels when compared with non-survivors. On the other hand, it was shown that survivors had significantly lower C3a (median (IQR): 203.0 (170.3–244.0) ng/mL vs 385.0 (293.0–424.8) ng/mL, p<0.001) and sC5b-9 (median (IQR): 294.0 (242.0–318.8) ng/mL vs 393.0 (342.0–436.5) ng/mL, p<0.001) levels when compared with non-survivors. Multivariate logistic regression analysis identified C3a (OR: 0.97 (95% CI 0.96 to 0.99), p<0.001) and C4 (OR: 0.92 (95% CI 0.86 to 0.98), p=0.011) levels as significant predictors of mortality. In conclusion, serum levels of complement factors are related to mortality in severely ill patients with COVID-19.

Correspondence on “Prognostic significance of complement factors in severely ill patients with COVID-19”

“…To the Editor, We recently have read with great interest the article written by Dr. Hassan et al published in October 2022 issue of Journal of Investigative Medicine. 1 The authors measured the serum levels of complement factors in hospitalized patients with severe course of coronavirus disease 2019 (COVID-19). The study showed that survivors had significantly higher C3 and C4 levels and lower levels of complement activation products, C3a and sC5b-9, and provided strong evidence on prognostic value of these complement factors for mortality.…”